Insurance Billing for Massage Therapists
Getting
Paid and what to do if you don’t get paid
Getting paid is of course the
trick to this all. Insurance companies will deny payments for varying reasons,
some of which are:
·
Incorrect procedure or diagnosis codes
·
Incomplete form: no diagnosis code, claim numbers etc.
·
Lost bills
·
No physician’s referral or prescription
·
Outdated referral or prescription
·
Treating other areas not included in the diagnosis code
·
Palliative care
·
Higher than usual UCR fees.
·
Didn’t send a copy of the prescription or referral with the bill
(not all require this)
·
You didn’t dot the letter i or cross the t.
·
The data entry person was having a bad day
·
The insurance company wanted to keep the money for themselves for
a while longer.
·
Some insurance companies may only allow so many dates of service
per bill (I haven’t found this – but have heard of others having this issue)
·
No prior authorization for treatment
·
No progress notes or chart notes sent with the bill
When a bill is denied, the
insurance company is responsible for letting you know why it has been denied.
It is often for an incomplete form, but there are also many other reasons.
The key to getting paid is
finding out ahead of time what each insurance company requires when you send the
bill. Start with the questions in the last chapter. If you are a provider with
a company, they will most likely have a manual with all the instructions. It is
recommended that you call each company as you get new clients and speak with a
representative about what they require and what massage therapy benefits they
allow. You may have to find the right person to talk to. It is often the case
manager, the actual billing person or it could be a provider representative. It
often helps to call a few times and ask the same questions of different people.
You will often find differences in what the service representative will tell
you. This will give you an idea of what it will be like working with this
company. If the client has an attorney, you should call and ask the attorney
the same questions. See what they require from you before you get too involved
in the case. It is also good to get aquatinted and set up a good working
relationship with the legal representatives as you may be working together on
other cases.
Often I have had insurance
companies tell me that a prescription or referral is not needed and when the
bill comes in it is denied due to lack of diagnosis code. This code must come
from the physician as massage therapists are not allowed to diagnose. It is a
process of learning all the little nuances that each company requires.
If you don’t get paid, you will
have some work to do. When you call insurance companies it is important to keep
track of who you talked to, what they said and what they said they would do.
(see form) Insurance companies often record their phone calls. I once got an
insurance company to pay based on what was said in a phone call that was
recorded.
When you start billing
insurance companies, you just have to accept the fact that there will be
problems and it will take time to get paid. The people who work for
insurance companies for the most part are not the ones to blame for not getting
paid. It is important to start out with respect and courtesy when working with
these people. You will often find that people will go out of your way to help.
When you find you have run out of options for getting the situation resolved,
you may need to start speaking to a supervisor. One of the problems you may
have with that is that the supervisor may not be informed of what is going on,
so it is important to keep good notes on what you have done to try and resolve
the situation.
It is also important to get the
client involved in such a situation. After all, they will be the one who is
responsible for paying the bill if the insurance company fails to pay. Give
them the tracking form to help track the calls. Letting the client take
responsibility for collecting payment takes the burden off of you.
When all else fails you can ask
the client to file a complaint with the
insurance commissioner’s office. Providers usually can’t file complaints,
but you may be able to write a letter that the client can provide as evidence
that payment is due.
